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General NPI Number Information
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NPI Number | 1225979297
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Entity Type | Individual
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Provider Name | CITLALI METZLI MORENO
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Gender | Female
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Dates
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Enumeration Date | 04/03/2026
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Last Update Date | 04/03/2026
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Provider Practice Location Address
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Address Line | 17130 SEQUOIA ST STE 104
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City | HESPERIA
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State | CA
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Zip | 92345-1827
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Country | US
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Telephone | 562-472-5246
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Fax |
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Provider Business Mailing Address
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Address Line | 4979 SMOKE TREE RD
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City | PHELAN
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State | CA
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Zip | 92371-8356
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Country | US
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Telephone | 442-427-2418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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